MEDICARE: LIADNIS LEGRA LOYOLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst		TX

General Provider Information

NPI Number	:	1457289035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIADNIS LEGRA LOYOLA

Provider Business Mailing Address
First Line	:	16722 CHESHIRE PLACE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-5210
Country	:	US
Telephone Number	:	346-629-2421
Fax Number	:

Provider Business Practice Location Address
First Line	:	16722 CHESHIRE PLACE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-5210
Country	:	US
Telephone Number	:	346-629-2421
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2026
Last Update Date	:	05/12/2026

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